Inspection on 14/09/06 for Fleetwood Hall

This inspection was carried out on 14th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fleetwood Hall 10/06/09

Fleetwood Hall 13/06/08

Fleetwood Hall 04/09/07

Fleetwood Hall 22/03/06

Fleetwood Hall 18/08/05

Fleetwood Hall 05/01/05

Fleetwood Hall 22/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Fleetwood Hall 100 Fleetwood Road Southport Merseyside PR9 9QN Lead Inspector Mr Mike Perry Unannounced Inspection 14th September 2006 09:30 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fleetwood Hall Address 100 Fleetwood Road Southport Merseyside PR9 9QN 01704 544242 01704 503956 yoyoearsden@karoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Newco Southport Limited Mr Malcolm George Francis Rugen Care Home 53 Category(ies) of Dementia (15), Mental disorder, excluding registration, with number learning disability or dementia (21), Old age, of places not falling within any other category (12), Physical disability (5) Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may admit four named service users over pensionable age within the category of mental disorder (MD). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social care Inspection. To admit one service user under pensionable age to the elderly care unit (OP). 22.3.2006 Date of last inspection Brief Description of the Service: Fleetwood Hall is a large detached building that occupies a position on the outskirts of Southport but within easy distance of the Town Centre and promenade. It was once an NHS hospital and has been converted to provide care over 3 floors. The registration is divided so that the ‘nursing’ units on the ground and top floor care for older persons, older persons with dementia and also younger adults with physical disability. The middle floor is given over to the Andrew Mason Unit [AMU], which admits younger adults with longer term and enduring mental health needs. This report therefore covers both sets of National Minimum Standards. The home has been owned and managed by Newco Southport Ltd since 1996. The responsible Person is Mr R. Oreschnick. The Registered Manager is Mr Malcolm Rugan. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted over a period of 3 days. All 3 units were visited. All day and recreation areas were seen and some but not all of the residents bedrooms. Care records and other records kept in the home such as health and safety records were also viewed. In total 12 residents in the home were spoken to along with 10 members of staff and the Manager as well as 2 student nurses on placement at the home. A placing social worker and advocate for 2 of the residents were interviewed. Relatives were interviewed by phone. All of the core standards were covered on the inspection. There were many positive aspects to the inspection and the management were responsive and open to comments made. Overall the home continues to improve. A registered manager has been in post for 9 months and has made steady progress towards meeting standards. The best achievement has been the upgrading of the care environment over this period. Staffing has also settled down and is now consistent with minimal turnover. Requirements and recommendations are listed at the end of the report. What the service does well: Care records seen on the nursing units contained assessments carried out by both nursing staff at the home and also by external professionals such as social workers and health care workers. Assessments cover both physical needs and psychological needs and also contain information about social background. The general atmosphere in the home is very warm and welcoming. This was commented on by visitors such as relatives and also other professionals who were spoken to. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 6 There was an understanding on the nursing units of the importance of facilitating good communication with residents and allowing them the time to develop their lifestyles. One resident commented ‘the staff are all fantastic in their attention, any ideas I have they try to act on’. Another resident commented that this ‘is my home’ and ‘I like it here very much’. The home has developed a number of regular activities over the last few years and continues to do so. There is now a designated staff member who organises activities and should continue to develop the social life in the home further. A resident commented ‘there is always something going on here’. Staffing levels are good on the AMU unit, which allows for one to one input for some of the more needy residents with respect to physical care and the importance of using this time for positive social interaction was a feature of the staff interviews conducted. Generally all residents praised the meals. There is good choice and residents said that they look forward to the choice of a cooked breakfast each morning. The dining arrangements for residents on all floors are sociable and pleasant. There is a complaints procedure in the home. The notice advertised in the home ‘problem – no problem’ highlights the complaints procedure in more immediate terms and is evidence of a positive attitude to the views of the residents and visitors. Relatives and residents interviewed felt that the staff approach to the care of vulnerable residents was supportative and respectful. These staffing ratios are consistent on all units and staff interviewed stated that staff turn over was minimal and is settled and consistent. Staff records were viewed and all were comprehensive in that staff information available and the required Criminal Records [CRB] and vulnerable adult checks [POVA] were recorded along with suitable references. Staff are well thought of by residents and visitors alike and there were many positive comments recorded through out the inspection and the support observed was appropriate and genuine. Resident’s monies are managed through the home residents monies account and the records are maintained satisfactorily. Residents interviewed had no problems in terms of the management of finances and were pleased that this was a convenient way of accessing monies. What has improved since the last inspection? Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 7 Following a requirement from the last inspection most staff have now received some training in abuse awareness and the local adult protection protocols for the reporting of any allegations. The general maintenance of the home has consistently been an issue in past inspection reports. There had been steady improvement to the environment on the last inspection and this has been maintained and built upon so that the home on this inspection was very acceptable. The manager has further plans to develop the environment in the home. The feedback from residents and relatives is that the general environment in the home has improved considerably. Comments were that ‘the home is always clean and fresh’. Following on from recommendations made in the last report the top floor unit now has more male staff presence to carry out personal care for male residents and the level of expertise in dementia care has improved with the introduction of two Registered Mental Nurse’s including the lead nurse on the unit. The home has suffered in the past due to a history of constant management changes over the past 5 -6 years and the new manager seems to have brought some stability to the role and has maintained steady progress in meeting the National Minimum standards the home is expected to achieve. What they could do better: Care files seen n the AMU were somewhat disorganised and one of the three care files seen did not contain any preadmission assessments and these could not be located. Some assessments for risk where not signed or dated an d other assessments were not completed. Discussion with the homes manager centred on the need to maintain full and accurate records for residents on the unit, which are also easy to access and read. This has been a feature of previous inspections. Staff generally felt that more could be developed for residents on the AMU and this should be an aim for the activities organiser. Only one resident had gone off for a holiday during the year and this should be further explored. [The manager stated that this was not a funding issue but one of resident volition]. There remains one requirement from previous inspections but the upgrading and replacement of windows in the home continues and should near completion in the near future. The recommendation previously for consideration of the furnishings in the home remains. Some items such as the Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 8 settee in the ground floor day room and some chairs on the AMU are in poor condition. The unit on the top floor is registered for dementia care. Again this was homely and had a warm feel. Flecks of paint from previous decoration projects spoil the day room floor and the rug is now old and worn and should be replaced. Care staff spoken to on the dementia care unit had had no updates or training in dementia care and this should be instigated so that the unit can develop as a specialist facility. Training was discussed with the staff. The current rate of NVQ trained care staff is still below the target of 50 . Staff reported some supervision [formal supervision] but this remains patchy [one staff spoken to had received no supervision] and remains a requirement. Records on the GF nursing unit are maintained in a filing cabinet in the nurse’s station, which is accessible. The cabinet was not locked. This was discussed with respect to confidentiality and security of information and must be addressed. There was also some discussion regarding a recent request by a relative for access to care records. There is a general policy on confidentiality but this perhaps needs o be developed to include specific guidelines on the homes procedure to access care records. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 OP, 2 YA The quality in this outcome group is adequate. This is based on available evidence. Residents are assessed prior to and during the admission process so that needs can be addressed. The records on the AMU need organising so that assessments are complete and information is readily available. EVIDENCE: Records were viewed on both nursing units and the AMU. Nursing Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 11 Care records seen contained assessments carried out by both nursing staff at the home and also by external professionals such as social workers and health care workers. The assessments are carried out prior to admission and also following admission. They are also repeated as needed on an ongoing basis. Assessments cover both physical needs and psychological needs and also contain information about social background. AMU Residents interviewed and care staff stared that assessments are always carried out prior to admission to the unit so that care needs can be identified and care costed accordingly. Care files seen were somewhat disorganised and one of the three care files seen did not contain any preadmission assessments and these could not be located. There were assessments for risk but some of these where not signed or dated. One resident had a social activities assessment but this was only half completed. Discussion with the homes manager centred on the need to maintain full and accurate records for residents on the unit, which are also easy to access and read. An auditing process is needed. This was also an issue on previous inspections. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality for this outcome group is adequate. This judgment is made on the available evidence. The health care needs of residents are addressed but there still needs to be some more consistency on the AMU with respect to care records reflecting the care as well as consistency of ongoing evaluation and reviews. EVIDENCE: Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 13 Nursing Care plans were reviewed on the ground floor nursing unit and also on the top floor dementia care unit. One care plan on the top floor unit is based on daily activities of living and all areas are covered although reference is made to areas that do not require any care interventions which makes it difficult to concentrate on those needs that are more relevant. For example ‘breathing’ is listed as a care need but the resident in question does not have any care needs in this area. The care plan is also ‘standardised’ and again there were care interventions listed that did not apply to the resident. For example ‘use sliding sheet’ to assist moving in bed but again this did not apply. The nurse in charge was aware of this problem and more recent care plans are now handwritten and needs are listed from the assessment process, which is much clearer and more personalised. There was little evidence of relative involvement with one resident although visits are regularly made. Other care plans seen on the ground floor unit were personalised and covered all of the areas of care for individual residents. One resident reviewed has multiple disabilities and communication difficulties and these were comprehensively covered with appropriate care interventions planned. The resident was observed to be receiving regular attention from staff who have established a positive relationship with him. The resident’s communication has improved considerably since the last inspection and this is reflected in the care notes. The resident spoke very positively about the staff and the care received and stated that ‘this is my home’. Residents were comfortable and appropriately dressed and it was observed that specialised equipment has been provided for residents who require it. It one bedroom of a resident with multiple physical and mental disability, specialised bed and mattress were in place and staff had been very careful to ensure that the television set [for example] was placed in a comfortable position so that the resident could view it. There were other positive examples of individualised care. Another resident who had recently died in the home had been nursed very successfully with support from the palliative care team and had been managed on the appropriate care pathway, which is evidence of good care. Dates of evaluations of the care plans were recorded but these tended to be brief statements such as ‘continue plan’. This was discussed with senior staff and the need for an evaluation to be a record of the residents progress set against the aims and objectives of the care plan was reinforced by the inspector. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 14 Medication administration charts were seen on the GF. All seen were clear in their recording with no omissions. Medication storage was satisfactory and the nurse stated that disused medicines are disposed of on a monthly basis [this is also recommended on the AMU who return medicines less frequently]. There were no residents on the nursing unit who were self-medicating due to associated risk factors. Standards of personal care on the elderly units were good. Those residents seen were clean and appropriately dressed. There are a proportion of residents nursed in bed and these were observed to be comfortable and regularly attended to. Staffing levels are maintained and care staff interviewed stated that they have time to give the care needed and do not feel ‘rushed’ in their care. AMU The care plans on the AMU were not as consistent in that while care plans are drawn up and all residents have a copy of the plan some have not been reviewed with any consistency so that changing needs are not recorded or addressed appropriately. One resident interviewed who had also been seen on the previous inspection had had no real evaluation or discussion of the care plan which was still dated in 2005. Another resident with complex physical and mental health needs had a care plan that was very brief although It did include a good analysis of the resident’s aggression and identified ‘triggers’ so that staff could be aware of these. The care plan was poorly evaluated however with only 2 entries made under ‘evaluation’ since May 2005. The relative interviewed stated that she had had little formal input into the care plan and had not seen it. There had also been no attendance at any of the clinical meetings with the consultant on the unit. The unit operates and primary nurse system although this is poorly identified and inconsistent. The Primary nurse recorded for one resident, for example, was not aware of this fact and on investigation staff [primary nurse] had been changed with no reference to the resident or relative. Despite poor records the outcomes for this resident was positive however. The care manager was contacted and reported that progress had been made whilst on the unit especially over recent months and that the residents communication and quality of life had very much improved. The relative confirmed this and stated that the staff were very supportative and approachable and had gained the trust of the resident who could be very difficult to manage. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 15 Other care plans seen were more consistent with needs identified and reviews recorded appropriately. Some residents reported that staff did discuss the care plans with them and this helped them to feel part of the care. Some of the residents reviewed on the AMU have poor volition in terms of being able to maintain their own personal care on the unit. Some residents spoken to were unable to maintain satisfactory standards of cleanliness either in their bedroom or for themselves. Following comments on the last report the staff have worked hard to ensure that standards of personal appearance and hygiene have improved and are now more consistent. Residents seen were clean and tidy. Relatives and advocates interviewed also supported this view. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality for this outcome group is good. This is based on available evidence. The home is able to demonstrate an understanding of need for residents with dementia as well as those younger adults with mental health needs to exercise some control over their lives so that their rights are respected EVIDENCE: Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 17 The general atmosphere in the home is very warm and welcoming. This was commented on by visitors such as relatives and also other professionals working in the mental health field who were spoken to. Nursing There was an understanding on the nursing units of the importance of facilitating good communication with residents and allowing them the time to develop their lifestyles. One resident commented ‘the staff are all fantastic in their attention, any ideas I have they try to act on’. Another resident with particular communication difficulties has input from the local advocacy service. The advocate was spoken to and commented that the home were very concerned that this resident should have a voice and as a result of continued input from staff was now able to talk and have a conversation. The same resident commented to the inspector that this ‘is my home’ and ‘I like it here very much’. The home has developed a number of regular activities over the last few years and continues to do so. There is now a designated staff member who organises activities and should continue to develop the social life in the home further. Residents spoke about trips out twice weekly in the mini bus and also frequent trips to town. There are social events organised including a regular coffee mornings were other care homes are invited as well as relatives. A resident commented ‘thee is always something going on here’. Residents with dementia can also join in these activities and staff spoke about a regular therapist who involved residents in physical activity sessions. The staff on the dementia care unit were keen to develop further and a dementia care periodical was recommended as a good source of both staff training and source of ideas for activities. The interactions between residents and staff were observed to be very supportative. AMU Likewise on the AMU some of the residents are limited in their ability to make some specific life choices but interviews were consistent in that residents are listened to and choices made on a daily basis are respected. One resident commented that more should be done in terms of getting involved in daily activity but when asked to describe the last couple of days had actually been quite busy both on and off the unit. Staffing levels are good on the unit, which allows for one to one input for some of the more needy residents with respect to physical care and the importance of using this time for positive social interaction was a feature of the staff interviews conducted. Visitors to the unit felt that the atmosphere was friendly and that residents ‘are supported’. Staff generally felt that more could be developed for residents on the unit and this should be an aim for the activities organiser. One staff member now does Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 18 a regular discussion group centred around current affaires and more in house activities like this should be facilitated. Only one resident had gone off for a holiday during the year and this should be further explored. [The manager stated that this was not a funding issue but one of resident volition]. Generally all residents praised the meals. There is good choice and residents said that they look forward to the choice of a cooked breakfast each morning. The dining arrangements for residents on all floors are sociable and pleasant. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality in this outcome group is good. This judgement is based on available evidence. The home provides a protective and caring environment so that residents are protected from abuse. EVIDENCE: Following a requirement from the last inspection most staff have now received some training in abuse awareness and the local adult protection protocols for the reporting of any allegations. The manager was able to talk about a difficult situation relating to one resident who has now been placed elsewhere and how this was death with effectively via a multi disciplinary approach involving health and social care professionals as well as advice from the police. There is a complaints procedure in the home and the manager has recorded 4 in-house concerns and complaints and these were discussed and had been acted on appropriately. The notice advertised in the home ‘problem – no problem’ highlights the complaints procedure in more immediate terms and is evidence of a positive attitude to the views of the residents and visitors. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 20 Relatives and residents interviewed felt that the staff approach to the care of vulnerable residents was supportative and respectful. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality in this outcome group is adequate. This is based on available evidence. There has been improvement to the general environment in the home and the maintenance programme outlined together with the recommendations in this report should ensure that satisfactory standards are maintained and residents live in a well-maintained environment. EVIDENCE: Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 22 The general maintenance of the home has consistently been an issue in past inspection reports. The building is both large and old and is in need of constant upgrading and repair. There had been steady improvement to the environment on the last inspection and this has been maintained and built upon so that the home on this inspection was very acceptable. The manager was able to demonstrate an ongoing programme, which has included décor, current upgrading of the electrical system, upgrading of bathrooms, and the creation of the sensory garden. There remains a constant need to budget and plan effectively if standards are to be both maintained and improved and the manager has further plans to develop the environment in the home. There remains one requirement from previous inspections but the upgrading and replacement of windows in the home continues and should near completion in the near future. The recommendation previously for consideration of the furnishings in the home remains. Some items such as the settee in the ground floor day room [difficult to clean smells of urine] and some chairs on the AMU are in poor condition. This was discussed with the manager who plans to replace some of these items and this should now be actioned. The feedback from residents and relatives is that the general environment in the home has improved considerably and all residents’ bedrooms seen were highly personalised and provide homely accommodation. Comments were that ‘the home is always clean and fresh’. All bathrooms, and bedrooms and day areas were clean and tidy, including the AMU, which has been difficult to maintain in the past. [There were some cushions from chairs being washed in the laundry as a result of some resident’s incontinence and this was discussed with the manager in terms of the suitability of some residents on the AMU]. The provision of dining room furniture together with tablecloths has greatly enhanced the dining room. There is a lack of space on the unit for meetings and general privacy. There is a small room, currently being used for storage of some files but this lacks space and still needs decorating. The manager is developing a separate staff room facility and this should create space on the ground floor for a meetings room. The unit on the top floor is registered for dementia care. Again this was homely and had a warm feel. Flecks of paint from previous decoration projects spoil the day room floor and the rug is now old and worn and should be replaced. Bedrooms were very well appointed and comfortable. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 23 There was some discussion wit the nursing in charge on the floor around specialising the unit more in terms of orientation aids for residents [signage, memory boxes, names on bedroom doors, orientation boards, etc] and this should be considered. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality in this area is good based on the available evidence. There are appropriately trained and experienced nurses and care staff employed so that residents feel supported and that their needs are understood and met although some areas of training and supervision still need addressing. Residents are protected by the homes recruitment processes, which include appropriate checks for all staff. EVIDENCE: Nursing For 12 residents on the G/F unit there was one trained and 3 care staff on duty at the time of the inspection. This is reduced to 1 trained and 2 carers for the afternoon shift. The top floor unit had 10 residents and was staffed with 1 trained nurse and 2 care staff. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 25 These staffing ratios are consistent and staff interviewed stated that staff turn over was minimal and is now settled and consistent. Following on from recommendations made in the last report the top floor unit now has more male staff presence to carry out personal care for male residents and the level of expertise in dementia care has improved with the introduction of two Registered Mental Nurse’s including the lead nurse on the unit. Care staff spoken to had had no updates or training in dementia care and this should be instigated so that the unit can develop as a specialist facility. The Alzheimer’s training package, access to dementia care periodicals and trained staff updates on specialist dementia care courses were discussed. AMU The AMU had 17 residents. Staffing on both days when visiting this unit consisted of 4 trained staff and 4 carers. There is one resident who is constantly on 1:1 staff input during the day. The figure also includes the unit manager. Resident reported that staff are always available. There are trained staff who are appropriately qualified and experienced with regard to nursing this client group. Again the rate of turnover of staff is currently low and there are therefore consistent personal on the unit. General. Staff records were viewed [3 in total] and all were comprehensive in that staff information available and the required Criminal Records [CRB] and vulnerable adult checks [POVA] were recorded along with suitable references. Files also contained some training certificates and supervision records. Training was discussed with the staff. Most were pleased with the training offered from induction through to access to NVQ which has been stepped up and there are currently 18 care staff undergoing the training. The current rate of NVQ trained care staff is still below the target of 50 . Staff reported some supervision [formal supervision] but this remains patchy [one staff spoken to had received no supervision] and remains a requirement. All staff spoken to had received statutory updates in manual handling health and safety issues. Staff are well thought of by residents and visitors alike and there were many positive comments recorded through out the inspection and the support observed was appropriate and genuine. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 26 Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality in this outcome group is adequate. This based on available evidence. There are some good quality initiatives that can be built on so that residents’ views can be instrumental in the running of the home and the service can Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 28 continue to improve. Some staff are receiving supervision but this needs to be further addressed so that all staff are supported in caring for residents. EVIDENCE: Malcolm Rugan is the Registered Manager for the home and has been in the management role for approximately nine months. He has worked in the home for a number of years and prior to appointment as manager was employed in a deputy management role. He is undertaking an NVQ course in management and has an RMN [Registered Mental Nurse qualification]. The home has suffered in the past due to a history of constant management changes over the past 5 -6 years and Malcolm seems to have brought some stability to the role and has maintained steady progress in meeting the National Minimum standards the home is expected to achieve. Feedback from staff, residents and visitors generally is that he is consistent in approach and is easy to communicate and talk to. The manager was able to discuss some developments in terms of the development of quality issues in the home. There is a yearly external audit that accesses both staff, resident and relative views of the home and provides feedback to the managers. There are various audits conducted regularly including health and safety audits, which are reported through the health and safety management team. There is also a clinical governance team consisting of management, staff and a relative and resident representative. Resident’s monies are managed through the home residents monies account and the records are maintained satisfactorily. Residents interviewed had no problems in terms of the management of finances and were pleased that this was a convenient way of accessing monies. The manager has commenced some staff supervision and has developed this from the previous inspection but staff interviews evidenced this still needs to be built on so that all staff receive supervision a least 6 times yearly. This was a requirement on the previous inspection Health and safety issues were reviewed with respect to fire safety and training, which have been addressed. The electrical wiring in the home continues to be upgraded during the inspection. Other maintenance certificates examined were up to date. Records on the GF nursing unit are maintained in a filing cabinet in the nurse’s station, which is accessible. The cabinet was not locked. This was discussed with respect to confidentiality and security of information and must be addressed. There was also some discussion regarding a recent request by a Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 29 relative for access to care records. There is a general policy on confidentiality but this perhaps needs o be developed to include specific guidelines on the homes procedure to access care records. Some registration issues were discussed. The home has a variation to their certificate for residents on the AMU who are over 65 years of age. One reviewed is possibly no longer in need of this placement as the reasons for the variation no longer apply. His needs would possibly be better met on the top floor unit. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 2 37 X 38 3 Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement Timescale for action 01/11/06 2. YA6 15 All residents admitted to the unit [AMU] must have a written assessment on file. This should be accessible in the care file. All care plans on the AMU must 01/11/06 be developed consistently so that all care needs are addressed and are reviewed regularly [previous requirement dates not met] The programme of replacing repairing windows must be completed. [Previous requirement dates not met] 01/02/07 3. YA24 OP19 23 4 OP19 YA26 23 5. OP36 18 The manager must audit the 01/11/06 suitability of furnishings on all units and replace those which are now unsuitable. All staff must receive regular and 01/11/06 ongoing supervision a least 6 times per year. [Last requirement dates not met]. The care records stored in the 01/11/06 nurses station on the GF must be maintained safely and securely by ensuring the cabinet is DS0000017279.V312163.R01.S.doc Version 5.2 Page 32 6 OP37 17 Fleetwood Hall locked. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations Some of the care files on the AMU are very disorganised and lack basic detail. All assessments, care plans etc need to be properly filed and completed with signatures and dates. Care plans and care files [nursing] should contain evidence of relative involvement for those residents who lack capacity. Evaluations should be more detailed and link to the aims and objectives on the care plan. There needs to be clear identification and management t of the primary nurse system on the AMU so that all staff are aware of their responsibilities. The activities coordinator should continue to develop her role and the provision of activities with particular reference to dementia care and the AMU. This includes the provision of holidays for long term residents who are ‘younger adult’ in the home. The manager on the top floor unit should consider orientation aids for residents as discussed and mentioned in this report. The flooring in the day room on this unit needs some attention and possible replacement t of carpet [ see report]. The furnishings on the AMU need to be given some consideration in terms of choosing items that are more easily maintained. Consideration should be given to ensuring care staff receives training and updates in dementia care [top floor unit]. The NVQ programme still need sot ensure 50 care staff trained to level 2. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 33 2 OP6 3 4 YA6 YA14 OP12 5 OP19 6. YA24 7 OP30 8 9 OP37 *RCN The manager should consider a policy / procedure around access to care records. The manager should give some consideration to the continued placement of the resident on the AMU [discussed] as the conditions of variation no longer apply. Fleetwood Hall DS0000017279.V312163.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 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